Impact of ventricle size on neuropsychological outcomes in treated pediatric hydrocephalus: an HCRN prospective cohort study

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  • 1 Department of Clinical Neurosciences, Alberta Children’s Hospital, University of Calgary, Alberta, Canada;
  • | 2 Department of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada;
  • | 3 Division of Pediatric Neurosurgery, Children’s of Alabama, Birmingham, Alabama;
  • | 4 Department of Neurosurgery, University of Utah, Salt Lake City, Utah;
  • | 5 Department of Neurological Surgery, Seattle Children’s Hospital, Seattle, Washington;
  • | 6 Division of Pediatric Neurosurgery, BC Children’s Hospital, University of British Columbia, Vancouver, Canada;
  • | 7 Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri;
  • | 8 Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;
  • | 9 Department of Pediatrics, University of Southern California, Los Angeles, California; and
  • | 10 Department of Pediatric Neurosurgery, Texas Children’s Hospital, Houston, Texas
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OBJECTIVE

In pediatric hydrocephalus, shunts tend to result in smaller postoperative ventricles compared with those following an endoscopic third ventriculostomy (ETV). The impact of the final treated ventricle size on neuropsychological and quality-of-life outcomes is currently undetermined. Therefore, the authors sought to ascertain whether treated ventricle size is associated with neurocognitive and academic outcomes postoperatively.

METHODS

This prospective cohort study included children aged 5 years and older at the first diagnosis of hydrocephalus at 8 Hydrocephalus Clinical Research Network sites from 2011 to 2015. The treated ventricle size, as measured by the frontal and occipital horn ratio (FOR), was compared with 25 neuropsychological tests 6 months postoperatively after adjusting for age, hydrocephalus etiology, and treatment type (ETV vs shunt). Pre- and posttreatment grade point average (GPA), quality-of-life measures (Hydrocephalus Outcome Questionnaire [HOQ]), and a truncated preoperative neuropsychological battery were also compared with the FOR.

RESULTS

Overall, 60 children were included with a mean age of 10.8 years; 17% had ≥ 1 comorbidity. Etiologies for hydrocephalus were midbrain lesions (37%), aqueductal stenosis (22%), posterior fossa tumors (13%), and supratentorial tumors (12%). ETV (78%) was more commonly used than shunting (22%). Of the 25 neuropsychological tests, including full-scale IQ (q = 0.77), 23 tests showed no univariable association with postoperative ventricle size. Verbal learning delayed recall (p = 0.006, q = 0.118) and visual spatial judgment (p = 0.006, q = 0.118) were negatively associated with larger ventricles and remained significant after multivariate adjustment for age, etiology, and procedure type. However, neither delayed verbal learning (p = 0.40) nor visual spatial judgment (p = 0.22) was associated with ventricle size change with surgery. No associations were found between postoperative ventricle size and either GPA or the HOQ.

CONCLUSIONS

Minimal associations were found between the treated ventricle size and neuropsychological, academic, or quality-of-life outcomes for pediatric patients in this comprehensive, multicenter study that encompassed heterogeneous hydrocephalus etiologies.

ABBREVIATIONS

Beery VMI-5 = Beery-Buktenica Development Test of Visual Motor Integration, Fifth Edition; BRIEF = Behavior Rating Inventory of Executive Function; CASL = Comprehensive Assessment of Spoken Language; CPC = choroid plexus cauterization; ETV = endoscopic third ventriculostomy; FDR = false discovery rate; FSIQ = full-scale IQ; FOR = frontal and occipital horn ratio; GPA = grade point average; HCRN = Hydrocephalus Clinical Research Network; HOQ = Hydrocephalus Outcome Questionnaire; IVH = intraventricular hemorrhage; JLO = Benton judgment of line orientation; NEPSY-II = NEPSY, Second Edition; PPVT-4 = Peabody Picture Vocabulary Test, Fourth Edition; WIAT-II = Wechsler Individual Achievement Test, Second Edition; WISC-IV = Wechsler Intelligence Scale for Children, Fourth Edition; WRAML-II = Wide Range Assessment of Memory and Learning, Second Edition.

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  • 1

    Drake JM, Kestle JT. Determining the best cerebrospinal fluid shunt valve design: the pediatric valve design trial. Neurosurgery. 1998;43(5):12591260.

    • Search Google Scholar
    • Export Citation
  • 2

    Santamarta D, Martin-Vallejo J, Díaz-Alvarez A, Maillo A. Changes in ventricular size after endoscopic third ventriculostomy. Acta Neurochir (Wien). 2008;150(2):119127.

    • Search Google Scholar
    • Export Citation
  • 3

    Tisell M, Edsbagge M, Stephensen H, Czosnyka M, Wikkelsø C. Elastance correlates with outcome after endoscopic third ventriculostomy in adults with hydrocephalus caused by primary aqueductal stenosis. Neurosurgery. 2002;50(1):7077.

    • Search Google Scholar
    • Export Citation
  • 4

    Kulkarni AV, Schiff SJ, Mbabazi-Kabachelor E, Mugamba J, Ssenyonga P, Donnelly R, et al. Endoscopic treatment versus shunting for infant hydrocephalus in Uganda. N Engl J Med. 2017;377(25):24562464.

    • Search Google Scholar
    • Export Citation
  • 5

    Kan P, Walker ML, Drake JM, Kestle JR. Predicting slitlike ventricles in children on the basis of baseline characteristics at the time of shunt insertion. J Neurosurg. 2007;106(5)(suppl):347349.

    • Search Google Scholar
    • Export Citation
  • 6

    Kulkarni AV, Hui S, Shams I, Donnelly R. Quality of life in obstructive hydrocephalus: endoscopic third ventriculostomy compared to cerebrospinal fluid shunt. Childs Nerv Syst. 2010;26(1):7579.

    • Search Google Scholar
    • Export Citation
  • 7

    Fletcher JM, Bohan TP, Brandt ME, Brookshire BL, Beaver SR, Francis DJ, et al. Cerebral white matter and cognition in hydrocephalic children. Arch Neurol. 1992;49(8):818824.

    • Search Google Scholar
    • Export Citation
  • 8

    Azab WA, Mijalcic RM, Nakhi SB, Mohammad MH. Ventricular volume and neurocognitive outcome after endoscopic third ventriculostomy: is shunting a better option? A review. Childs Nerv Syst. 2016;32(5):775780.

    • Search Google Scholar
    • Export Citation
  • 9

    Mandell JG, Kulkarni AV, Warf BC, Schiff SJ. Volumetric brain analysis in neurosurgery: Part 2. Brain and CSF volumes discriminate neurocognitive outcomes in hydrocephalus. J Neurosurg Pediatr. 2015;15(2):125132.

    • Search Google Scholar
    • Export Citation
  • 10

    O’Hayon BB, Drake JM, Ossip MG, Tuli S, Clarke M. Frontal and occipital horn ratio: a linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus. Pediatr Neurosurg. 1998;29(5):245249.

    • Search Google Scholar
    • Export Citation
  • 11

    Kulkarni AV, Drake JM, Armstrong DC, Dirks PB. Measurement of ventricular size: reliability of the frontal and occipital horn ratio compared to subjective assessment. Pediatr Neurosurg. 1999;31(2):6570.

    • Search Google Scholar
    • Export Citation
  • 12

    Feudtner C, Christakis DA, Connell FA. Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980-1997. Pediatrics. 2000;106(1 Pt 2):205209.

    • Search Google Scholar
    • Export Citation
  • 13

    Gioia GA, Isquith PK, Retzlaff PD, Espy KA. Confirmatory factor analysis of the Behavior Rating Inventory of Executive Function (BRIEF) in a clinical sample. Child Neuropsychol. 2002;8(4):249257.

    • Search Google Scholar
    • Export Citation
  • 14

    Kulkarni AV, Drake JM, Rabin D, Dirks PB, Humphreys RP, Rutka JT. Measuring the health status of children with hydrocephalus by using a new outcome measure. J Neurosurg. 2004;101(2)(suppl):141146.

    • Search Google Scholar
    • Export Citation
  • 15

    Kulkarni AV, Rabin D, Drake JM. An instrument to measure the health status in children with hydrocephalus: the Hydrocephalus Outcome Questionnaire. J Neurosurg. 2004;101(2)(suppl):134140.

    • Search Google Scholar
    • Export Citation
  • 16

    Benjamini Y, Hochberg Y. Controlling the false discovery rate—a practical and powerful approach to multiple testing. J R Stat Soc Series B Stat Methodol. 1995;57(1):289300.

    • Search Google Scholar
    • Export Citation
  • 17

    Warf B, Ondoma S, Kulkarni A, Donnelly R, Ampeire M, Akona J, et al. Neurocognitive outcome and ventricular volume in children with myelomeningocele treated for hydrocephalus in Uganda. J Neurosurg Pediatr. 2009;4(6):564570.

    • Search Google Scholar
    • Export Citation
  • 18

    Chatzidakis EM, Barlas G, Condilis N, Bouramas D, Anagnostopoulos D, Volikas Z, Simopoulos K. Brain CT scan indexes in the normal pressure hydrocephalus: predictive value in the outcome of patients and correlation to the clinical symptoms. Ann Ital Chir. 2008;79(5):353362.

    • Search Google Scholar
    • Export Citation
  • 19

    Isaacs AM, Smyser CD, Lean RE, Alexopoulos D, Han RH, Neil JJ, et al. MR diffusion changes in the perimeter of the lateral ventricles demonstrate periventricular injury in post-hemorrhagic hydrocephalus of prematurity. Neuroimage Clin. 2019;24:102031.

    • Search Google Scholar
    • Export Citation
  • 20

    Lean RE, Han RH, Smyser TA, Kenley JK, Shimony JS, Rogers CE, et al. Altered neonatal white and gray matter microstructure is associated with neurodevelopmental impairments in very preterm infants with high-grade brain injury. Pediatr Res. 2019;86(3):365374.

    • Search Google Scholar
    • Export Citation
  • 21

    Erickson K, Baron IS, Fantie BD. Neuropsychological functioning in early hydrocephalus: review from a developmental perspective. Child Neuropsychol. 2001;7(4):199229.

    • Search Google Scholar
    • Export Citation
  • 22

    Donders J, Rourke BP, Canady AI. Neuropsychological functioning of hydrocephalic children. J Clin Exp Neuropsychol. 1991;13(4):607613.

    • Search Google Scholar
    • Export Citation
  • 23

    Barnes MA, Dennis M. Reading in children and adolescents after early onset hydrocephalus and in normally developing age peers: phonological analysis, word recognition, word comprehension, and passage comprehension skill. J Pediatr Psychol. 1992;17(4):445465.

    • Search Google Scholar
    • Export Citation
  • 24

    Dennis M, Barnes MA. Oral discourse after early-onset hydrocephalus: linguistic ambiguity, figurative language, speech acts, and script-based inferences. J Pediatr Psychol. 1993;18(5):639652.

    • Search Google Scholar
    • Export Citation
  • 25

    Dennis M, Jacennik B, Barnes MA. The content of narrative discourse in children and adolescents after early-onset hydrocephalus and in normally developing age peers. Brain Lang. 1994;46(1):129165.

    • Search Google Scholar
    • Export Citation
  • 26

    Barnes MA, Pengelly S, Dennis M, Wilkinson M, Rogers T, Faulkner H. Mathematics skills in good readers with hydrocephalus. J Int Neuropsychol Soc. 2002;8(1):7282.

    • Search Google Scholar
    • Export Citation
  • 27

    Dennis M, Barnes MA, Hetherington CR. Congenital hydrocephalus as a model of neurodevelopmental disorder. In: Tager-Flusberg H, ed. Neurodevelopmental Disorders: Contribution to a New Perspective from the Cognitive Neurosciences. MIT Press;1999:505532.

    • Search Google Scholar
    • Export Citation
  • 28

    Fletcher JM, Brookshire B, Bohan TP, Brandt M, Davidson K. Early hydrocephalus. In: Rourke BP, ed. Syndrome of Nonverbal Learning Disabilities: Neurodevelopmental Manifestations.1st ed. Guilford Press;1995:206238.

    • Search Google Scholar
    • Export Citation
  • 29

    Thompson NM, Fletcher JM, Chapieski L, Landry SH, Miner ME, Bixby J. Cognitive and motor abilities in preschool hydrocephalics. J Clin Exp Neuropsychol. 1991;13(2):245258.

    • Search Google Scholar
    • Export Citation
  • 30

    Fletcher JM, Dennis M, Northrup H. Hydrocephalus. In: Yeates KO, Ris MD, Taylor HG, eds. Pediatric Neuropsychology: Research, Theory, and Practice.Guilford Press;2000:2546.

    • Search Google Scholar
    • Export Citation
  • 31

    Korshunov AE, Shakhnovich AR, Melikian AG, Arutiunov NV, Kudriavtsev I. Cerebrospinal fluid dynamics in chronic obstructive hydrocephalus before and after successful endoscopic third ventriculostomy. Article in Russian. Zh Vopr Neirokhir Im N N Burdenko. 2008;(4):1724.

    • Search Google Scholar
    • Export Citation
  • 32

    Kulkarni AV, Sgouros S, Leitner Y, Constantini S. International Infant Hydrocephalus Study (IIHS): 5-year health outcome results of a prospective, multicenter comparison of endoscopic third ventriculostomy (ETV) and shunt for infant hydrocephalus. Childs Nerv Syst. 2018;34(12):23912397.

    • Search Google Scholar
    • Export Citation
  • 33

    Drake JM, Kulkarni AV, Kestle J. Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric patients: a decision analysis. Childs Nerv Syst. 2009;25(4):467472.

    • Search Google Scholar
    • Export Citation

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